Vol 87, No 1 (2015)

High-risk and secondary prevention strategies for noncommunicable diseases in primary health care are mainly implemented by local therapists. The large-scale clinical examination of an adult population (a high-risk strategy), which has been launched in the country since 2013 to solve the problems of detecting people with noncommunicable diseases and their risk factors and making a prevention counseling, is simultaneously a mechanism for the formation of a full therapeutic area passport to identify follow-up groups (a secondary prevention strategy). Currently, there is an obviously insufficient follow-up of inadequate quality. The reasons for this situation are a lack of regular training of local doctors in follow-up in addition to staff shortages. Medical teachers and professional communities working on the basis of common guidelines must be attracted to solve this problem. The actual introduction of a local therapist's efficient performance measures, the setting up of special structures in charge of primary care prevention in the health authorities, and the active involvement of medical prevention and health centers (for people at high risk in the absence of proven non-communicable diseases) in this process will be able to enhance the efficiency of a follow-up. Information technologies, including a tele-follow-up, are an important reserve in implementing the high-risk and secondary prevention strategies.

Aim. To establish gender differences in health attitudes and awareness of risk factors for cardiovascular diseases in an open 25-64-year-old population of Russia/Siberia. Subjects and methods. A representative sample from the population of a Novosibirsk district was examined using the 1988 WHO MONICA-MOPSY (847 women and 739 men aged 25-64 years) and the 2003 HAPIEE (1074 women and 576 men aged 45-64 years) programs. The health awareness and attitudes questionnaire was used. Results. The number of persons who considered perfectly healthy was minimal (2%) in the open Siberian population aged 25-64 years. The view of health in the women proved to be more pessimistic than that in the men. The fact that two thirds of the population could fall ill with a serious disease in the coming 5-10 years was accepted. Mainly the men took the view that modern medicine might prevent heart disease. The men were regularly examined 2 to 3 times more often than the women. The latter versus the men were less frequently inclined to stop work if they felt not quite well on-site, with the difference being more marked in old age groups. The majority of the study participants considered preventive examination to be useful for health. At the same time only a small portion of the population itself undergoes examination. Conclusion. The changed socioeconomic situation in the country leads to the need to alter the established stereotypes of conscience and behavior of the population in health and to realize the need for personal responsibility for health.

Aim. To study the efficiency of a methodology for the active detection of coronary heart disease (CHD) and cerebrovascular diseases (CVD) during medical examination and to determine the need and possible ways of its improvement. Subjects and methods. The medical examinations of 19.4 million people (94.6% of all the citizens who had undergone medical examinations in all the regions of Russia in 2013) were analyzed and the methodological aspects of identification of the circulatory diseases (CDs) that were induced by coronary and cerebral vessel atherosclerosis and had common risk factors, primarily CHD and CVD, were assessed. Results. The medical examinations revealed 2,915,445 cases of CDs and their suspicions, during which its clinical diagnosis was established in 57.2%. The suspected disease requiring that its diagnosis should be further specified; off-medical examinations revealed hypertension in more than 770,000 cases, CHD in 232,000, and CVD in 146,000. The proportion of stable angina pectoris of all angina cases was much higher at a young age (25.6%) than at middle (15.6%) and elderly (11.3%) ages. Brachiocephalic artery stenoses were detected in almost 13,000 cases. According to the official health statistics, within the years preceding the introduction of large-scale medical examinations, there was a slight rise in new CD cases among the adult population of Russia, which was more significant in 2013 (according to the preliminary data) than in 2012. Conclusion. The methodology for the active detection of CDs through a two-step medical examination, which is used during a follow-up, makes it possible to substantially increase detection rates for CDs. There has been shown to be a need for the better quality and completeness of diagnostic examination in real practice.

Aim. To describe hemodynamic and clinical changes in patients with elevated mean pulmonary artery pressure (MPAP) >30 mm Hg during exercise and the impact of bosentan therapy on stress-induced pulmonary hypertension (SIPH). Subjects and methods. The study included 19 patients with systemic sclerosis (SDS) in whom possible causes of pulmonary hypertension (PH) (lung and left heart injuries and thromboembolism) were excluded. All the patients underwent pulmonary artery catheterization at rest and during exercise. The hemodynamic (right atrial pressure (RAP), systolic and diastolic pressure, MPAP, pulmonary artery wedge pressure (PAWP), cardiac output (CO) by a thermodilution technique), clinical (demographic, immunological, and instrumental) parameters were analyzed and the risk of pulmonary arterial hypertension (PAH) was also calculated; 5 patients with SIPH received 16-week bosentan therapy according to the conventional regimen. Results. Ten of the 19 patients were at increased risk for PAH in accordance with the DETECT scale, but no signs of PH at resting catheterization were found in anybody. In 5 patients, MPAP, was in the range from 21 to 24 mm Hg; in 9 (47%) patients were found to have SIPH, a median MPAP of 35 (32; 41) mm Hg. Seven patients had no diagnostic changes during exercise; 3 patients could not perform an exercise test. There were correlations between MPAP and DETECT risk scores (p<0.05). The patients with SIPH had significantly higher levels of resting MPAP and exercise pulmonary vascular resistance (PVR) and PAWP. The calculated DETECT risk was significantly higher in the SIPH group. The level of uric acid was also higher in the SIPH group (p<0.05). There were no changes in NT-proBNP levels, telangiectasias and anti-centromere antibodies, and EchoCG and lung test results. During 16-week bosentan therapy, there was a significant decrease in MPAP and transpulmonary gradient during exercise, but PVR, MPAP/CO ratio and NT-proBNP levels tended to decrease. Conclusion. In the patients with SDS, SIPH may be a stage of pulmonary vasculopathy that precedes the development of clinical PAH. The use of current PAH-specific drugs used at the preclinical stage of the disease may substantially improve lifetime prognosis in patients with SDS-associated PAH.

Aim. To assess the expediency of psychotherapy in patients with essential hypertension (EH) from clinical and economic standpoints. Subjects and methods. Seventy-five (37 men, 38 women) with grades 1-2 EH (blood pressure (BP) was 140/90 to 179/109 mm Hg) and the verified psychosomatic background of the disease) were examined and randomized into 2 groups (the mean age in Groups 1 and 2 was 48.5±3.69 and 47.5±4.2 years, respectively). All the patients received medical therapy using the same regimen; however, Group 1 patients had additionally psychotherapy. The decrease in BP and the average number of visits required to reach goal BP were estimated as a criterion for therapeutic effectiveness. A pharmacoeconomic analysis of antihypertensive therapy was made in each group. Results. The average cost for 24 weeks was 349.67 rbl per person in Group 1 and 435.9 rbl in Group 2, which was 19.78% cheaper. The costs of reductions in systolic BP (SBP) and diastolic BP (DBP) were also lower in Group 1 (-22.108 and -39.534 rbl, respectively). At the same time, goal BP was achieved more rapidly in Group 1 (in Groups 1 and 2, the reduction in SBP was 5.28 and 3.38 mm Hg weekly and that in DBP was 2.51 and 1.73 mm Hg weekly, respectively). This makes it possible to lower a physicians' load and to save timing budget (p>0.032). Conclusion. The treatment policy in Group 1 surpassed that in Group 2 in the rate of BP normalization and the number of required visits to a physician and showed significant economic benefits.

Aim. To study the influence of environmental factors (EFs) on the development of cardiovascular diseases in the population of industrial towns of the Republic of Kazakhstan. Subjects and methods. The investigation covered an 18-59-year-old adult population who had been living in the urbanized areas of the Republic of Kazakhstan for at least 10 years, who worked in harmless conditions and were unregistered as having chronic diseases. At Stage 1, screening (a therapist's examination, blood general and immunological tests, and electrocardiography) was carried out for risk group persons who underwent in-depth clinical examination (blood biochemical test) at Stage 2. Results. Multivariate statistical analysis has revealed that the development of hypertension is associated with the high concentration of sulfur dioxide in atmospheric air, copper in dust sediments, and zinc in soil and that of coronary heart disease (CHD) is related to the high levels of nitrogen dioxide in atmospheric air and zinc in dust sediments. Conclusion. Based on pathogenetic and statistical data and information available in the literature, hypertension and CHD are referred to as the diseases that may result from the influence of EFs.

Aim. To evaluate the efficacy and safety of Аrbidol (umifenovir) in adult patients with influenza. Subjects and methods. The analysis of the preliminary results of the multicenter double-blind randomized placebo-controlled post-marketing study ARBITR was performed. A total of 293 adults aged 18 to 65 years with influenza or acute respiratory tract infection of no more than 36 hours' duration were enrolled in the study. Individuals were randomized into 2 treatment groups: oral umifenovir 200 mg four times daily for 5 days or placebo four times daily for 5 days. The efficacy endpoints were time to resolution of all symptoms, severity of symptoms and illness, durations of virus shedding. Results. The efficacy of umifenovir was evaluated in the group of 119 (40.6%) patients with influenza: 45 patients with laboratory-confirmed influenza and 74 patients whom diagnosis of influenza was made based on clinical and epidemiological data. Umifenovir had influence on the time to resolution of all symptoms. All symptoms were resolved within the first 60 hours after therapy initiation in 23.8% patients with laboratory-confirmed influenza in the umifenovir group and it was 5.7 times greater compared to placebo group (4.2%) (p<0.05). Severity of illness, catarrhal symptoms and intoxication was reduced with umifenovir compared to placebo, reducing of severity was most evidently observed within the first 2-3 days following the therapy initiation. Umifenovir had a significant effect on viral shedding. The proportion of patients still shedding influenza virus on day 4 was significantly reduced in the umifenovir group compared to placebo (25 vs 53%, respectively; p < 0.05). Conclusion. It was found that the effect of umifenovir in the treatment of influenza in adults is most pronounced in the acute stage of the disease and appears in the reduction of time to resolution of all symptoms of the disease, reducing the severity of symptoms of the disease and durations of virus shedding.

The paper considers the role of the immune system, endoplasmic network stress, metabolic dysregulation, and epigenetic mechanisms in the pathogenesis of essential hypertension, as well as the limited possibilities of therapy with existing antihypertensive agents.

The prevalence of type 2 diabetes mellitus (DM) and preceding metabolic disturbances has reached epidemic proportions. Oxidative stress plays a significant role in the development of micro- and macrovascular complications in patients with DM. The accumulation of free radicals is responsible for the development of systemic and vascular inflammation, endothelial dysfunction, and hypercoagulable and ischemic states. Since vascular and nervous system damages do not level off even under adequate glycemic control, there is a need for complex pathogenetic treatment strategies. Antioxidant therapy using mexidol is one of the compulsory components of combination therapy for complications of DM.

Much previous experience accumulated by physicians in various wars and local military conflicts provides strong evidence that it is necessary to set up a harmonious system to deliver therapeutic care during wartime, which is based on the unity of views on the origin, course, and treatment of pathological processes having regard to the specific conditions under which armed forces are involved in combat operations. This all has given rise to the new branch of therapy - field therapy. The Great Patriotic War was the most important stage in the development of Russian field therapy, which was characterized by the setting up of the effective and scientifically ground system to deliver therapeutic care to the wounded and patients, which was based on the tenets of a uniform field medical doctrine.